Patofisiologi Luka

Bakar dan Terapi N

utrisi
dr. Rauza Sukma Rita, Ph.D

Definisi Luka Bakar

suatu bentuk kerusakan dan atau kehilanga
n jaringan disebabkan kontak dengan sumbe
r yang memiliki suhu sangat tinggi.
Kerusakan akut yang disebabkan panas, listr
ik, dan zat kimia

Insiden
Sekitar 310.000 orang di seluruh dunia men
inggal karena luka bakar
30 % diantaranya berusia di bawah 20 tahu
n

ETIOLOGI
Paparan api
Flame
Benda panas (kon Aliran listrik
tak)
Zat kimia

Scalds (air panas)

Uap panas
Gas panas

Radiasi
Sunburn

panas

listrik

Zat radioakif

Zat kimia

laser

petir

ledakan

Kehidupan
sehari-hari

Klasifikasi Luka Bakar

Berdasarkan derajat dan kedalaman luka b
akar
1. Superficial (first-degree)
2. Deep (second-degree)
3. Full thickness (third and fourth degree)

4/1/2011

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SUPERFICIAL BURNS
(FIRST DEGREE)
Epidermal tissue only affected
Erythema, blanching on pressure, mild sw
elling
no vesicles or blister initially
Not serious unless large areas involved
i.e. sunburn

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4/1/2011

15

DEEP (SECOND DEGREE)

*Involves the epidermis and deep layer of th
e dermis
Fluid-filled vesicles red, shiny, wet, severe
pain
Hospitalization required if over 25% of bod
y surface involved
i.e. tar burn, flame

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FULL THICKNESS (THIRD/FOUR

TH DEGREE)
Destruction of all skin layers
Requires immediate hospitalization
Dry, waxy white, leathery, or hard skin, no
pain
Exposure to flames, electricity or chemical
s can cause 3rd degree burns

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Perhitungan Luas Permukaan Tu

buh yang Terkena
1.Metode permukaan telapak tangan
area permukaan tangan pasien (termasuk ja
ri tangan) adalah sekitar 1% total luas permu
kaan tubuh.
Digunakan pada luka bakar kecil

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Metode Permukaan Telapak Tangan

Perhitungan Luas Permukaan Tubu

h yang Terkena
2. Metode rule of nine
Metode yang baik dan cepat menilai luka b
akar menengah dan berat pada penderita ber
usia di atas 10 tahun.

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RULES OF NINES
Head & Neck = 9%
Each upper extremity (Arms) = 9%
Each lower extremity (Legs) = 18%
Anterior trunk= 18%
Posterior trunk = 18%
Genitalia (perineum) = 1%

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Perhitungan Luas Permukaan Tubu

h yang Terkena
3. Metode diagram oleh Lund and Browder
Metode yang paling akurat pada anak bila d
igunakan dengan benar.

Lund Browder Chart used for determining

Body Surface Area (BSA)

29 2007)
Evans, 18.1,

Patofisiologi Luka Bakar

Respon Lokal
Segera setelah kontak permukaan kulit denga
n sumber panas nekrosis kulit yang terkena.
Tiga zona luka bakar :
1. Koagulasi
2. Stasis
3. Hiperemis

1. Zona Koagulasi
Area yang terkena kontak erat dengan sumb
er panas
.Sel pada area ini mengalami nekrosis koagu
lasi dan tidak membaik
.Kehilangan jaringan bersifat irreversibel

2. Zona Stasis
Area konsentris yang kerusakan jaringannya
lebih sedikit
Ditandai penurunan perfusi jaringan
Jaringan pada zona ini berpotensi untuk dise
lamatkan

3. Zona Hiperemis
Zona terluar di mana perfusi jaringan menin
gkat
Sel pada area ini mengalami trauma minimal
Pada sebagian besar kasus akan membaik d
alam 7-10 hari

Zona Luka Bakar Menurut Jackson

Patofisiologi Luka Bakar

Respon Sistemik
Tergantung luas luka bakar
Luka bakar > 20 % total permukaan tubuh respon sistemik
Dua fase pada penderita luka bakar :
1. Fase ebb terjadi 24 jam pertama
hipometabolisme
2. Fase flow setelah 24 jam
olik

peningkatan konsentrasi hormon

katab

Kondisi hipermetabolik menyebabkan perubahan metabolism

karbohidrat, lemak dan protein

Patofisiologi Luka Bakar

Gangguan metabolism karbohidrat
Peningkatan gluconeogenesis
Resistensi insulin
Gangguan metabolism protein
Terjadi proteolysis yang bisa berlangsung 4
0-90 hari paska luka bakar
Penurunan lean body mass hingga setahun
paska luka bakar

Patofisiologi Luka Bakar

Gangguan metabolism lemak
Peningkatan lipolysis
Gangguan makronutrien
Penurunan zat besi, seng, selenium, vitamin
C, tokoferol, retinol, dan vitamin A

Respon metabolik terhadap luka bakar

Manifestasi Klinis Luka Bakar

Reaksi Lokal
Kemerahan
Bengkak
Nyeri
Perubahan sensasi

Manifestasi Klinis Luka Bakar

Reaksi Sistemik
pada luka bakar yang luas
Syok hipovolemik luka bakar > 25 % luas
permukaan tubuh
Hipotermia
Perubahan metabolik

Terapi Luka Bakar

1.Pertolongan emergency
remove heat source
avoid re-damage
lessen contamination
control pain
manage combined injury

cold therapy

Terapi Luka Bakar

2.Terapi Umum
(1. Correct burn shock
2. Prevention and treatment of
systemic infection
3. Nutritional support

(1) Correct burn shock

choice of fluid: water, crystalloid,
colloid
route for fluid administration:
peripheral, central vein
volume and rate of infusion:

24h volume = 1.5ml%burnweight (kg)

(2) Prevention and treatment of

systemic infection
control of wound infection
systemic antibiotics
support therapy

(3) Nutritional support in burned patients

Burns are a tissue injury resulting in

protein denaturation
edema
loss of intravascular fluid volume
caused by chemical, thermal, radiation, or el
ectrical contact.

Nutrition in burned patients (cont.)

There are three important reactions of the

body to a burn injury, which include
Metabolic
Hormonal
Immune Response

Nutrition in burned patients (cont.)

Feeding the burned patient

The first 24-48 hours of nutritional interven
tion replaces lost fluid and electrolytes.
Initiation of feeding is recommended within
4-12 hours of hospitalization.

Nutrition in burned patients (cont.)

Calculation of energy needs

is usually based on the Curreri method:
24 kcal kg usual body weight + 40 kcal %
TBSA (with a maximum of 50% TBSA)

Adults are often calculated to need 35-40

kcal/kg/day.

Nutrition in burned patients (cont.)

Nutritional Requirements
CHO: Glucose administration at a rate of 5
mg/kg/min is optimum for adults. The child
glucose requirement is 5-7 mg/kg/min.
Lipid: 15% of energy requirements is suffici
ent.

Nutrition in burned patients (cont.)

Protein: approximately 25% of total energy sh

ould come from protein.
Adults : 1g protein /kg + 3g x % burn.
Children : 3g protein/kg + 1g x % burn.

Arginine
Is one amino acid important in the healin
g of burn wounds associated with:
Reduced hospital stay & infection rate.
It is also a precursor to nitric oxide, which in
creases blood flow to the wound and causes v
asodilatation.

Glutamine
Another important amino acid has been s
hown to
Preserve integrity of the intestinal mucosa,
Reduce infection and maintain immune functi
on in burn patients
Decrease the translocation of bacteria and ba
cterial survival in animals.
Ornithine -ketoglutarate, a precursor of gl
utamate and glutamine, has been shown to b
e beneficial when administered to burn patien
ts.

Nutrition in burned patients (cont.)

Vitamin requirements :
Vitamin A, which is important in proper imm
une function and epithelialization, in the am
ount of 10,000 IU/day and 5,000 IU/day in c
hildren under three years old.
Vitamin C supplementation are 250 mg twic
e daily for children under 10 years old and 5
00 mg twice daily for adult.

Nutrition in burned patients (cont.)

Minerals
Are also important to monitor in the nutritional
care of burn patients. Supplementation of zin
c, copper, and selenium during the first week.
Calcium, phosphorus, magnesium, sodium, an
d potassium levels monitored cautiously.

Prevention:

Terima Kasih